October 20, 2021

The facility was designed as a destination spot for state-of-the-art care.

CREDIT: Emory Healthcare
ROOM FOR GROWTH Emory Musculoskeletal Institute's outpatient ORs are outfitted with the latest technologies surgeons use to perform complex cases.

The new Emory Musculoskeletal Institute in Brookhaven, Ga., brings a host of surgical services to a single location, giving patients convenient access to comprehensive orthopedic and spine care. An ultramodern ambulatory surgery center, imaging facility, and physical therapy and rehab spaces form the institute's core, but a wide range of extra features were built with accessibility and interconnectivity in mind.

Patients park for free in an attached parking garage with close to 800 spaces. Inside the institute, they can access an interactive website that provides details about available care programs and even guides them through a digital tour of the artwork that hangs throughout the building. Large flat-screen monitors in each exam room display background information about the physicians with whom patients meet and diagrams of surgical procedures based on the care plans of individual patients.

The facility was designed with eco-friendly features that include strategic lighting that limits light pollution, water management solutions that capture and contain 95% of stormwater runoff, automatic tinting glass on the sunny side of the building that helps to control temperatures and reduce energy consumption needed to cool the interior, and monitors that automatically increase fresh air flow where staff and patients are gathered.

"The new building will assist in attracting and retaining the best faculty, staff, trainees and researchers, while serving patients for both routine and complex orthopedic treatment and care," says Jonathan S. Lewin, MD, CEO of Emory Healthcare and executive vice president for health affairs for Emory University. "We expect the Emory Musculoskeletal Institute to be a destination musculoskeletal facility."

The all-inclusive center is part of a larger strategy to increase access to specialized services.

CREDIT: Jason Joseph
LOCAL ATTRACTION Ohio State University Wexner Medical Center is building community-based healthcare hubs.

The recently opened 251,000-square-foot Ohio State University Wexner Medical Center's Outpatient Care New Albany is the flagship site of the health system's initiative to expand its ambulatory care offerings to where patients live and work.

The one-stop-shop for care — one of three such facilities planned by the health system — allows patients to schedule appointments with various providers, including cardiologists, gastroenterologists, orthopedists and physical therapists. Providing patients with access to numerous specialists in a single location allows for the convenient delivery of comprehensive care, from prevention to surgery.

"The events of the past 17 months have underscored the importance of high-quality, accessible health care to improve long-term outcomes and save lives," says Ohio State University President Kristina Johnson. "Outpatient Care New Albany is an example of Ohio State's longstanding commitment to share our resources and expertise with the communities we serve."

Patients have access to advanced imaging services and can leave with needed medications provided by an on-site pharmacy. In addition, the center offers a walk-in immediate care clinic for treatment of serious illnesses and injuries.

The facility's outpatient ORs host colorectal, cosmetic, general, gynecological, orthopedic, urologic and vascular procedures. Patients can receive pre-op evaluations and testing in the facility before undergoing surgery in the in-house surgery center, and receive post-op follow-up care under the same roof.

"We understand that health care has to fit into the busy lives of our patients. With this suburban outpatient care center, we're going beyond the traditional centralized hospital approach to improve patient-centered care, access and reduce patient costs," says Dan Like, chief administrative officer of Ohio State Ambulatory Services. "By providing immediate, specialized and preventive care in one location in these communities, we can better care for patients close to their home or work."

From concept to finish and beyond, this Phoenix surgeon partnered with Stryker to open a state-of-the-art ASC.

Credit: Stryker

"Starting a surgery center is a huge endeavor," says Dr. Brian F. Gruber, an orthopedic surgeon from Phoenix, Arizona. He should know. Dr. Gruber started that journey in 2018 and today is the founder of a state-of-the-art surgery center located in central Phoenix that offers the community a robust total joints program. In what used to be a grocery store, the new building project is a prime example of how a partnership with Stryker can turn a dream into reality.

Dr. Gruber decided to partner with Stryker to bring to life his vision of creating an ambulatory surgery center that could perform up to 20 total joints surgeries in a day. Rather than doing what he calls a "piecemeal" approach for the various stages of design, construction and equipping the center, he chose to work with one company for the entire process. Taking advantage of their comprehensive approach, he partnered with Stryker to work together every step of the way to open an ASC that would be exactly what Dr. Gruber imagined.

"Our partnership allowed us to build a first-class center. We were one of the first that they [Stryker] really coordinated with, and we are proud of that," notes Dr. Gruber. "We chose to go with Stryker for a best-in-class center that empowers our practice."

Integrated Surgical Services is impressive the minute you walk in the door, with a welcoming lobby that puts patients at ease. The rest of the massive center: four operating rooms, five pre-op bays, and five post-op bays, is equipped throughout with Stryker products. "The breadth of the Stryker product line is powerful," says Dr. Gruber. For surgeons working here, they will find that the ORs are equivalent to the size of a hospital OR, with state-of-the art equipment including Mako SmartRobotics^™.

A Sterile Processing Department (SPD) provides efficient instrument cleaning and sterilization right on the premises, which allows for fast turn-over as well as a high volume of total joints procedures possible in one day.

Patient safety and comfort are a top priority at Integrated Surgical Services. The center's custom design includes recovery rooms that allow the staff to take the best care of the patients post-surgery. Physical therapy is given within two hours of surgery under the care of the professional PT staff.

This relationship is unique to Stryker's ASC business and has built confidence for Dr Gruber and his team. "It empowers our practice to do what we wanted to do," says Dr. Gruber. "This facility allows us to take the best care of our patients."

Watch Dr. Gruber bring Integrated Surgical Services to life here.

Note: Learn more about Stryker's ASC business here.

Leading surgeons team up to study the practicality of discharging patients on the day of surgery.

It's feasible and safe to perform multi-level cervical artificial disc replacements in surgery centers, according to research published in the journal Spine.

Todd Lanman, MD, Jason Cuellar, MD, PhD, and Alexandre Rasouli, MD — spine surgeons at Cedars-Sinai Medical Center in Los Angeles — conducted the nine-month outcomes study, which considered patients' age, gender, body mass index, tobacco use and presence of diabetes. It also assessed the level of spine operated on, the length of procedures, blood loss, intraoperative complications, where patients were discharged to, and rates of reoperations, readmissions, post-op complications and surgical site infections.

In total, 147 patients underwent 231 levels of disc replacements, including 71 single-level and 76 multi-level replacements. The average age of the patients was 50 years; 71 were women and 76 were men. None of the patients were on insulin to treat diabetes and four were current users of tobacco. The average length of the surgeries was 88 minutes. Nine out of 10 patients were discharged to home, and nearly 10% were sent to an after-care facility to recover.

The surgeons reported two minor post-op complications that resulted in unplanned hospital admissions within 90 days of surgery. "We believe that these procedures are safe to perform in an ASC," they say. "An efficient surgical team and careful patient selection criteria are critical in making this possible."

Performing the procedures in outpatient ORs is safe and effective.

There are no significant differences in the short-term complications and long-term results of hip replacement procedures performed in outpatient facilities and inpatient ORs, says a study published in the Journal of Orthopaedic Surgery and Research.

The comparison of two-year outcomes of 91 patients who had their hips replaced in outpatient facilities and 91 patients who had the same procedures done in inpatient ORs found no difference in rates of readmissions, emergency room visits, unplanned follow-up care, complications and surgical revisions. More than 90% of patients in both groups were discharged to home, and less than 10% were discharged to skilled nursing facilities to recover. Patients were an average of 53 years and 55 years of age in the outpatient and inpatient groups, respectively.

Fast-track perioperative care and robotic assistance are recent developments that contribute to the continuing shift of hip replacements to the same-day setting, say the researchers, who point to estimates that say half of total hip replacements will be performed in outpatient facilities by 2026.

Most of the surgeons involved in the study operated using the direct anterior approach and employed a robotic-assisted total hip system to develop a pre-op surgical plan, make patient-specific cuts and align the implant during surgery. Patients in the outpatient group were discharged after they were medically stabilized, their pain was adequately controlled and they ambulated as soon as they were able. Patients in the inpatient group remained hospitalized for at least one night until they met the same discharge criteria.

The researchers say their findings address patient safety and post-op complications — primary concerns about performing hip replacements in same-day surgical settings. "Outpatient total hip arthroplasty can achieve improved postoperative patient-reported outcomes compared with inpatient hip replacements in appropriately selected, younger patients," they write.